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APPLICATION/FOR PLM B ING PERMIT ,
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS el
LOCALITY
WATER CLOSET
NEAREST
BATH TUB CROSS ST ,
SHOWER OWNER `+-�?C-�/I✓/L�I�L
MAIL
LAVATORY ADDRESS
SINK CITY TEL NO 1 .
DISHWASHER 'CONTRA T
CLOTHES WASHER ADDRES 0920 E. GRAND AVE.
SWIMMING POOL RECEPTOR CITY TC-RAP
LE C) lye C/1I -�n 0
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER OQ LICENSE NO CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR 5 SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING,
GAS PIPING
GAS VENT u
@S
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
VD
Plan check fee UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ �Q
TOTAL FEE FINAL
Plan check applicant CH K VALIDAT N
r
Name
Address f7
City Tel No !
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES '7
AND STATE LAWS REGULATING PLUMBING' PERMIT VALIDATION �
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS i. /ry
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE (�(
LEGAL OWNER OF AND INTEND TO ABOVE DESCRIBED RESIDENTIAL 7/,��
PROPERTY 77
SIGN E
OFPERMI
DISTRICT NO P S BY
INDUSTRIAL V
WASTE APPROVAL